Rewire Youth Club Registration Form / Contact Update

PLEASE COMPLETE ONE FORM FOR EACH CHILD

Name of child (required)

School year group (required)

Date of birth (required)

School (required)

Home address (required)

Postcode (required)

Parent/Guardian name (required)

Contact number (required)

Email address (required)

Emergency Contact 1

Contact name (required)

Relationship to child (required)

Contact number (required)

Emergency Contact 2

Contact name (required)

Relationship to child (required)

Contact number (required)

Does your child have any medical conditions or allergies we need to be aware of? (Please clarify if ’traces of’) (required)

Dietary requirements (Vegetarian, Vegan, Religious) (required)

Does your child have any additional needs that we may need to know? (required)

Do you give consent for photos to be used for publication purposes on social media? (required)

YesNo

Password for pickup (required)

If there is confidential information that you do not wish to write on this form, please speak to a member of staff.

This information will be stored and only used for the purpose of the youth club, in line with The Data Protection Act 2018.

Send